Reweaving a Tapestry of Care: Religion, Nursing, and the Meaning of Hospice, 1945–1978

See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/238446888 Reweaving a Tapestry of Care: Religion, Nursing, and the Meaning of Hospice, 1945–1978 Article in Nursing History Review · September 2006 DOI: 10.1891/1062-8061.15.113 CITATIONS READS 11 370 1 author: Joy Buck West Virginia University 14 PUBLICATIONS 172 CITATIONS SEE PROFILE Some of the authors of this publication are also working on these related projects: Palliative Care Needs in Rural Serious Illness: An Ethnographic Study View project All content following this page was uploaded by Joy Buck on 11 March 2015. The user has requested enhancement of the downloaded file. Reweaving a Tapestry of Care: Religion, Nursing, and the Meaning of Hospice, 1945-1978 JOY BUCK University of Pennsylvania School of Nursing ... people who have worked in general and chronic wards do seem to think it is tather epoch-making that evety one of our patients looks peaceful, contented, and free from pain, whenever they come round the hospice. I do not pretend for a moment that [it] is my work... Of course, most of the work is just the good nursing.' When British physician Cicely Saunders wrote those words to a colleague, she was in the process of blending the religious roots of hospice with an academic model of clinical research on pain control for terminally ill cancer patients at St. Joseph's Hospice in London. In preparation for building St. Christopher's, a hospice of her own, she wrote a series of letters to physicians in the United States to learn more about how Americans cared for terminally ill cancer patients. In 1963, Saunders made the first of many trips to the United States to visit medical centers and universities across the country and to lecture about the benefits of the "good nursing" and her work at St. Joseph's. Her eloquent descriptions of the hospice philosophy of care resonated with a small but growing cadre of idealistic nurses, clergy, and physicians who believed that medical care for the dying had grown increasingly impersonal and technologically managed. At the time Saunders began her correspondence with the Americans, she did not know that broad economic, social, and cultural changes underway in the United States were creating an environment ripe for reform. Nor could she have foretold how the transatlantic transfer of knowledge, research, and ideals would serve as a catalyst to ignite the American hospice movement. This article examines transitions in community-based care for the dying before and after the inception of the American hospice movement. Specifically, the early development of modern hospices in Britain and the state of Con- necticut (1945-1974) is used as a case study to examine the interplay among religion, nursing, and the modern conceptualization of hospice. Beginning with a discussion of the antecedents of modern hospices, the article explores how these shaped Saunders's conceptualization of hospice as both place and systematic Nursing History Review 15 {2007): 113-145. A publication of the American Association for the History of Nursing. Copyright @ 2007 Springer Publishing Company. 114 JOY BUCK approach to caring for the dying. This is followed by an examination of how and why the transatlantic exchange of knowledge and ideas brought a multidis- ciplinary group together to advance hospice as a necessary health care reform in the United States and the challenges the group faced as they moved toward integrating hospice into the American medical system. In reconstructing the history of hospice, I argue that, although the modern hospice concept may have been in sharp contrast to standard medical and nursing care for the dying in some academic medical centers, it was not wholly different from nursing care provided at home and in specialized homes for the dying in both Britain and the United States. Although few of these homes were called hospices, they were critical to the modern conceptualization of hospice as both a place and philosophy of care for the dying. Previous studies of the American hospice movement typically begin by trac- ing the word hospice, linking earlier hospices to the creation of modern hospitals, and then quickly move to Cicely Saunders and the founding of the modern hospice movement.^ As historian Clare Humphreys argues, this preoccupation with the term "hospice" has resulted in the obfuscation of the role that other earlier homes for the dying played in caring for the terminally ill.^ Moreover, the centrality of medical institutions and physicians in these analyses obscures the significance of the roles of families, nurses, and religious groups in community- based care for the dying and the development of modern hospices. Building on previous scholarship on the institutionalization of life's beginning and end in Canada and home care in the United States,^ this study illuminates the links between faith traditions, personal ideologies, shifting professional paradigms, culture, and class that remain invisible in much modern scholarship of hospice. Weaving a Tapestry of Care: Early Homes for the Dying The meaning of hospice has changed through history. The earliest hospices were Christian centers where travelers and the poor, sick, and dying could find comfort and respite. During the late nineteenth and early twentieth centuries, care of the dying was primarily within the realm of the family. Although the "deserving poor" who were sick could enter voluntary hospitals for care, institutional biases afforded higher priority to patients with the potential for cure. Once diagnosed as incurable, the dying poor were sent home or to asylums and almshouses to be cared for until they died.' Beginning in the late nineteenth century, a number of homes opened in the British Isles and America to provide specialized care for the hopelessly ill poor. Most, although not all, of these homes were founded and Reweaving a Tapestry of Care 113 operated by Catholic, Methodist, and Anglican religious groups. Although there were denominational differences in their approach to care for the dying, they were united in their dedication to a "social gospel" that called them to serve the poorest of the poor.^ One of the earliest institutions with an explicit commitment to care of the dying was founded by the Irish Sisters of Charity in Dublin. Mother Mary Aikenhead, founder of the order in 1816, had a special love and concern for dying patients that she "honored as pilgrims departing on a longer journey."^ In 1879, twenty-one years after Mother Aikenhead's death, the sisters founded Our Lady's Hospice, the first hospice in Dublin committed solely to care of the dying. The hospice's initial charter attests to its mission: "Long and sadly has been felt the want of an institution into which those who have no relative or friend to watch beside them in their last hours may be received, tended by charitable hands, comforted and prepared for their passage to eternity."^ The sisters soon acquired a reputation for making the "passage from life to death through a brief darkness a happy one." Our Lady's Hospice's first annual report, published in 1882, documented that during its first three years of existence, the nuns provided terminal nursing care for 336 patients and were "generally well received by the public." The report, which was distributed to the hospice's benefactors, characterized the sisters' attitudes toward their patients by the following: "No words can express the gratitude felt by those whose privilege it is to carry out this great work."^ Historically, compassion, comfort measures, and spiritual care for the sick and dying were the cornerstones of hospice care. The medical knowledge and technology that make optimal symptom management a possibility today were limited. According to a report of expenditures at the forty-bed Our Lady's Hos- pice, from September 1881 to September 1882, £518 was spent on meat; £251 on groceries, wine, and spirits; and £175 on medical attendance and pharmacy. The majority of patients at the hospice died of consumption; the mainstay of symptom management was the use of whiskey mixed with milk, a common treat- ment for many diseases at the time, but especially tuberculosis.'" The amount spent on the chapel and chaplains was almost identical to that spent on medical attendance and pharmacy and is indicative of the limited pharmacopoeia and the high value early hospices placed on spiritual care for the dying. At the turn of the twentieth century, the nuns opened another home, St. Joseph's Hospice for the Dying, to meet the medical, social, and religious needs of the terminally ill in London. At St. Joseph's, special attention was given to helping patients achieve what was called "soul cures" when a physical cure was not possible." These "soul cures" depended on the individual's acceptance of the Catholic faith and participation in its specific rituals. Although spiritual healing 116 JOY BUCK was paramount, it was generally accepted that this could not be accomplished until the person's physical and mental suffering had been alleviated. The individual was the primary focus of care, but a patient's social and familial relationships were also important. "The sisters believed that happy and holy deaths should be edifying to others, especially non-Catholic relatives, and that estranged family members should be reconciled."'^ Thus, care was extended to the patients' families as well. Another example of an early home for the terminally ill in London was St. Luke's Home for the Dying Poor, founded in 1893 by Dr. Howard Barrett, with affiliations with the Methodist Church.'^ Like St. Joseph's, St. Luke's made clear distinctions between paupers and the "respectable poor" the institution was meant to serve.' Whereas the power and authoritative control of St.

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